Awakening the Sleeping GiantHow Technology will Elevate the

Effectiveness and Visibility of Patient Access

Paul Shorrosh, MSW, MBA, CHAMFounder & CEO, AccuReg Patient Access Solutions

NAHAM Board Member and Southeast Regional Delegate

Ever feel like this in Patient Access?

Time to Wake Up!…to our potential

Change Drivers

• Increased patient responsibility• 48 million uninsured• More Medicaid-eligible population than ever• 2-4% avg US hospital operating margin• 30% of hospitals with <0% operating margins• ACO’s and VPB (Value Based Purchasing)• Complexity of registration and billing

= more required of Patient Access?

What More Might We Do?

• Order/Referral Mgmt• Demographic Verification• Insurance Verification• Medical Necessity• Service Authorizations• Quality Assurance

• Price Transparency• Payment Estimation• Collect current & past

due balances• Financial Clearance

– Credit & Payment History

– Charity or Medicaid– Discounts & Pmt Plans

…At POS and Pre-Arrival

Multi-Step Process

AV ID IV MN Auth POS Fin Clr QA

Demographics Identity Address Orders

Insurance Verify COB MN Auth

Clearance Qualify Estimate Collect Arrange

Quality Review Correct Train

Specialization

Centralized/System Approach

QualityException

QueueInsurance

Verification

Address Verification

Identity Verification

Payment Estimation

& Collection Financial Assistance

Qualification

Medical Necessity

Service Auth/Cert

Evolution of Quality Assurance

Manual QADifficultIneffectiveCostly

Automated QA 1% in 200519% in 200835% in 2011

Auto QA & Management ToolsProductivityAccuracyPerformanceVolume StaffingWait/Reg Times

Auto QA, Management & Education ToolsTrainingTestingScoringImmediate Coaching & Guidance

QA CENTRAL HUBInsurance VerificationAddress/ID VerificationPayment Estimation & Collection Service AuthorizationMedical NecessityFinancial Assistance Qualification & ClearancePrice TransparencyComprehensive ReportingSaaS & Mobile Devices

Person-Centered QA Environment

sdddddddddd

Insurance Verification

Address Verification

Identity Verification

Payment Estimation &

Collection

Financial Assistance

Qualification

Medical Necessity

Service Auth/Cert

• Initiate Request• Open Response• Read Response• Find Relevant Info• Interpret Relevant Info• Identify Variances• Correct Variances• Resolution Rate KPI

• Initiate Request• Open Response• Read Response• Find Relevant Info• Interpret Relevant Info• Identify Variances• Correct Variances• Verification Rate KPI

Exhibit A: Insurance VerificationShift from Analysis to Resolution

Variances RequiringResolution

Copay/Ded

Benefits

Coverage

Exhibit B: Pre-RegistrationShift from Activation to Completion

Past Pre-Reg Process:• Account activation• • • • • • • • • Pre-reg to scheduled rate KPI?

Future Pre-Reg Process:• Account activation• ID & Address Verification• Insurance Verification• Authorizations• Medical Necessity• Payment Estimate/Collect• Pre-qual for Fin Assist• Payment plan setup• Quality Assurance• Pre-Reg Completion Rate KPI?

How will we make this shift?

Source: Multitasking Makes us Stupid, CPU Blog March 22, 2006 http://headrush.typepad.com/creating_passionate_users/2006/03/multitasking_ma.html

Multi-tasking Tools?

Well, sure! But… the real change we must drive is not to do more work, but to do different work

Working Different Requires Patient Access Technology that will:

• Keep pace with growing complexity & duties• Multitask, audit and distill for user action• Automate, centralize, standardize & interact• Serve, educate and empower the person• Enforce behavioral change (issues resolved)• Demonstrate value:

– Increased duties– Improved quality– Revenue cycle results

NAHAM InitiativesRegistration Components and Time Estima

tesFTE Calculator• Develop Key Performance Indicators

– For Patient Access Processes– Result-focused vs activity-focused– Comparison to peers– Correlate to back-end metrics to prove value

• Identify and Publish Best Practices

We can do this.

Patient Access Leaders

It is not the strongest of the species that survives, nor the most intelligent, but the

one most responsive to change.Charles Darwin

Survivors adapt to change… Leaders drive change!

Paul Shorroshpaul@accuregsoftware.com

251-338-3443